孕产期D-二聚体变化与产后肺栓塞发生的关系  

Relationship between changes of D-dimer levels during pregnancy and risk for postpartum pulmonary embolism

作　　者：刘倩倩[1] 郁君[2] 吴桂珠 LIU Qianqian;YU Jun;WU Guizhu(Department of Urogynecology,Obstetrics and Gynecology Hospital,School of Medicine,Tongji University,Shanghai 201204,China;Department of Obstetrics,Obstetrics and Gynecology Hospital,School of Medicine,Tongji University,Shanghai 201204,China)

机构地区：[1]同济大学附属妇产科医院盆底与泌尿妇科,上海201204 [2]同济大学附属妇产科医院产科,上海201204

出　　处：《同济大学学报（医学版）》2024年第4期516-520,共5页Journal of Tongji University(Medical Science)

基　　金：上海市科学技术委员会医学创新项目(22Y11906200)。

摘　　要：目的探讨孕产期D-二聚体变化与产后肺栓塞的发生关系。方法回顾性收集2018年1月—2023年1月建卡分娩的孕产妇临床资料,分别在建卡、分娩前和产后收集检测血浆D-二聚体浓度值等资料,根据产妇产后是否发生产后肺栓塞分为病例组和对照组,探讨孕产期D-二聚体变化与产后肺栓塞的发生关系和临床预测价值。结果病例组和对照组受孕方式、身高、体重、BMI、胎停次数差异无统计学意义(P>0.05);而年龄、胎数、孕次、产次差异有统计学意义(P<0.05),病例组具有年龄更大、多胎次和多胎的特点,随着孕周的增加,病例组D-二聚体水平呈逐渐升高的趋势;病例组和对照组产后D-二聚体水平差异有统计学意义(Z=-4.520,P<0.05),在建卡和分娩前D-二聚体水平差异均不存在统计学有意义(建卡Z=-0.669,P=0.504;分娩前Z=-0.804,P=0.421);产后D-二聚体水平变化可以反映和提示血栓性疾病的出现,即产后D-二聚体越高(6.32518.25 mg/L),越偏向于有肺栓塞。结论孕产期血浆D-二聚体水平呈增高趋势,产后血浆D-二聚体的变化对于产后肺栓塞的发生具有影响作用,考虑到疾病动态发展的特性,对于孕产妇发生静脉血栓栓塞应结合更多指标进行多方面考虑和管理。Objective To explore the relationship between the change of D-dimer during pregnancy and the occurrence of postpartum pulmonary embolism.Methods The clinical data of 279 pregnant women who were registered for antenatal check-up and delivery in Obstetrics and Gynecology Hospital of Tongji University from January 2018 to January 2023 were analyzed retrospectively.Plasma D-dimer levels were dynamically detected and documented.Postpartum pulmonary embolism occurred in 104 cases(case group),pregnant women without pulmonary embolism served as control group(n=168).The relationship between the changes of D-dimer levels during pregnancy and the occurrence of postpartum pulmonary embolism was analyzed.Results There was no significant difference in conception mode,maternal height,weight and BMI,and the number of fetal arrest between the case group and the control group(P>0.05).There were significant differences in age,number of births,gravidity and parity(P<0.05)between two groups.There was higher proportion of pregnant women with older age,multiple births and multiple births in the case group.The plasma D-dimer levels were elevated with the increase of gestational age in the case group.The postpartum D-dimer levels in the case group were significantly higher than those in the control group(Z=-4.520,P<0.05);while there were no significant differences in D-dimer levels at time of registration and pre-delivery period(Z=-0.669,P=0.504;Z=-0.804,P=0.421)between two groups.The higher postpartum D-dimer levels(6.325-18.25 mg/L)were associated with the risk of pulmonary embolism.Conclusion The levels of plasma D-dimer during pregnancy and childbirth show an increasing trend.The changes of plasma D-dimer during postpartum period may increase the risk of the occurrence of postpartum pulmonary embolism.

关 键 词：静脉血栓栓塞症 D-二聚体 产后肺栓塞 

分 类 号：R714[医药卫生—妇产科学]